Five years after five patients died with a deadly fungal infection they received from hospital linens, Children's Hospital officials on Thursday began contacting the families to inform them their loved ones were affected by the outbreak.

Dr. John Heaton, medical director for the New Orleans pediatric hospital, said during an organized press conference that the hospital did not act appropriately with respect to informing families of patients of the outbreak, which lasted from August 2008 to July 2009.

"Regrettably, it's become clear that, while we made an extraordinary effort to identify and contain this infection, we did not make an extraordinary effort to communicate with our families and disclose the nature of this illness," Heaton said. "It's personally appalling to me that we find that some of the families are finding out that their child was involved in this outbreak by reading the newspaper."

Tyrel Caden Gee, a premature baby born at Touro Infirmary on July 12, 2008, died on his 44th day alive while he was in the Neonatal Intensive Care Unit at Children's. Days before he passed, his mother saw a scratch near his groin that she says developed overnight into a major infection that ate away much of his diaper region.

She says she always suspected he contracted something in the hospital, but she never received answers and was not informed that her child's illness was part of what the hospital later determined was an outbreak.

Heaton said the hospital "dropped the ball" when it came to communicating with patients' families. "We failed to do what we should have done," he said.

"This was not done to conceal anything nor with malice aforethought," he said. "I think in our zeal to comply -- or go above the standards for compliance and focus on stopping the infection -- we forgot those who went before. And, again, we regret that."

Mucormycosis is a rare fungal infection that is caused by fungi found in dirt and decaying organic matter such as leaves. In the case of the Children's Outbreak, investigators with the Centers for Disease Control determined the infection was most likely transmitted to children through linens after they were laundered.

At the time, according to lawsuits by two families of the deceased patients, the hospital was using TLC Services, a New Orleans launderer that counted Children's as its only medical client.

Heaton stressed that the children who acquired the fungus in the hospital and died were all "gravely ill," and most had immunosuppression from other diseases.

By the time the hospital began investigating the matter on June 22, 2009, three children had died with the infection. Heaton said at that point, nurses identified similarities in the lesions between a patient there in June and another that had been cared for in March.

"And although up until that point, all of our normal procedures had been complied with and all of our policies had been followed, it wasn't until some clinicians put together two and two that the alarm went off," he said.

A fourth child died on July 2, 2009, at which point records show the hospital reached out to the Louisiana Office of Public Health, who in turn asked the CDC to help with an investigation.

Records obtained by NOLA.com | The Times-Picayune show that in 2008, Children's Hospital's policy required the hospital to treat hospital-acquired infections "that result in death or major permanent loss" to be handled as sentinel events requiring the hospital perform what is known as a "root cause analysis" -- a systematic study of why the infection happened.

Such an analysis, had it been conducted when Tyrel Gee died, likely would have helped the hospital detect early on that the fungus had been transmitted through the linens, thus stemming the outbreak.

Asked about the policy, Heaton said that because the mucormycosis diagnosis was a contributing cause of death in already very ill patients -- and not a primary cause of death -- that the hospital did not treat the cases as sentinel events and did not conduct a root cause analysis.

And though Heaton described the fungus as a rare infection, he said that the individual cases didn't stand out in part because the hospital was used to seeing one or two cases a year of community-acquired mucormycosis every year.

"It was very difficult to detect the commonality with our standard, very robust protocol for surveillance for hospital-acquired infections," Heaton said.

The Joint Commission, which accredits hospitals and counts Children's among its members, has a policy that encourages members to report sentinel events. And while the policy does not require hospitals to self-report, it states that if The Joint Commission learns of a sentinel event another way, the hospital is expected to conduct a root cause analysis in a timely fashion. Not doing so could affect a hospital's accreditation status.

Dr. Brobson Lutz, former Orleans Parish Medical Director and a physician who specializes in internal medicine and infectious diseases, said hospitals regularly find "wiggle room" in the definition of what constitutes a sentinel event.

"I would have classified it as a sentinel event," Lutz said of the individual outbreak deaths. "Now, doctors and hospital administrators frequently differ on what a sentinel event is. It's hard to raise the bar so low that a hospital administrator can't slip under it."

Despite Heaton's insistence that the hospital followed its policies with respect to detecting the outbreak, he maintained a tone of regret.

He said he had called three families on Thursday to inform them that their children died as part of an outbreak. He planned to reach out to others by mail or phone. Heaton said he believes most of the affected patients were informed their children had a fungal infection but he couldn't say how many, if any, had been informed of the outbreak.

The conversations were painful, he said.

"I'm extremely concerned that any kid suffered any morbidity that they didn't need to suffer because of something that we did in the process of taking care of them."

Told of Heaton's statements, Gee said she had not heard anything from hospital officials on Thursday. She sounded insulted that all these years later she may hear from Children's through the mail.

"A letter? A letter?" Gee said. "And what's the letter supposed to say? If they could not find me before how could they send me a letter now?"

The hospital couldn't confirm whether Gee's son, Tyrel Gee, was indeed the first affected patient due to patient confidentiality laws. But shortly after NOLA.com | The Times-Picayune posted a breaking story online that included her reaction, Heaton emailed the news organization asking if it had a working number for Cassandra Gee.

Staff writer Rebecca Catalanello can be reached at rcatalanello@nola.com or 504.717.7701.

Clarification: The Joint Commission encourages members to report sentinel events. And while the policy does not require hospitals to self-report, it states that if The Joint Commission learns of a sentinel event another way, the hospital is expected to conduct a root cause analysis in a timely fashion. Not doing so could affect a hospital's accreditation status. An earlier version of this story oversimplified The Joint Commission's requirements.

Correction: Tyrel Gee was born on July 12, 2009. An earlier version of this post had a different day. The story has been corrected.